Provider Demographics
NPI:1952710014
Name:CHRISTOPHER, VIENGCHITH (RDH)
Entity Type:Individual
Prefix:
First Name:VIENGCHITH
Middle Name:
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 SE 140TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3865
Mailing Address - Country:US
Mailing Address - Phone:503-975-3850
Mailing Address - Fax:
Practice Address - Street 1:9201 SE 91ST AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3760
Practice Address - Country:US
Practice Address - Phone:503-253-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-03
Last Update Date:2014-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4990124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist